Ruminations by a non-academic general surgeon from the heart of the rust belt.

Wednesday, April 22, 2009

Torture Doctors

This article from ProPublica focuses on an aspect of the torture scandal that has, for the most part, escaped notice; the role of physicians and medical providers in the "enhanced interrogation techniques". From the beginning of the Bush/Cheney era of torture, the CIA's Office of Medical Services (OMS) personnel "were involved in designing safeguards for, and in monitoring implementation of, the procedures used on other high value detainees", according to the recently released OLC memos. Isn't that nice? Here are a few choice quotes from the article:

Perhaps the most chilling aspect of the memos is their intimation that medical professionals conducted a form of research on the detainees, clearly without their consent. "In order to best inform future medical judgments and recommendations, it is important that every application of the waterboard be thoroughly documented," one memo reads. The documentation included not only how long the procedure lasted, how much water was used and how it was poured, but also "if the naso- or oropharynx was filled, what sort of volume was expelled....and how the subject looked between each treatment." Special instructions were also issued with regard to documenting experience with sleep deprivation, and "regular reporting on medical and psychological experiences with the use of these techniques on detainees" was required.

The memos describe the techniques in highly precise and clinical detail, befitting a medical textbook. During water boarding, in which a physician and psychologist were to be present at all times, "the detainee is monitored to ensure that he does not develop respiratory distress. If the detainee is not breathing freely after the cloth is removed from his face, he is immediately moved to a vertical position in order to clear the water from his mouth, nose and nasopharynx." Side effects including vomiting, aspiration and throat spasm that could cut off breathing were each addressed: "In the event of such spasms...if necessary, the intervening physician would perform a tracheotomy."

While physician assistants could be present when most "enhanced" techniques were applied, "use of the waterboard requires the presence of a physician," one memo said, quoting the OMS Guidelines.

Joseph Mengele would be so proud!

Yes, I know, that's three posts in one week on the torture scandal. But it cannot be emphasized enough, in my opinion. We live in a country where a sitting U.S. President was impeached in 1998 because he lied about getting a blow job from a lowly intern. I think we'd all agree that what we're dealing with now just might be something a little more worthy of such intense public scorn. What we have now is a situation where an executive branch unilaterally defied international law and the US Constitution by designing and codifying a program, yes a program, of torture, kept it secret, justified it with bad faith legal arguments from hacks like Jay Bybee, and then lied about it when the harrowing details began to leak out ("the United States does not torture!"). And even now Dick Cheney has the gall to go on Fox News with Sean Hannity and sneer in his condescending way about how President Obama has put us in danger by rescinding the illegal torture policies he now unabashedly claims "prevented any more terrorist attacks on American soil since 2001".

But that's not the point, you see. Leaving aside all teleologic arguments for the justification of torture (and if there are documented cases of the effectiveness of torture in this program, I also want to know to what degree torture could be expected to be effective, i.e. was it 80% effective, 20%, 0.2%, and did we have to waterboard detainees 100 times or 10 before they coughed up the goods, it all needs to be exposed in all its gory detail because if you're going to implicate me as an American in this heinous, pre-meditated torture policy, I deserve to know what I'm buying into) leaving aside all that (those arguments are weak anyway), the point of the matter is that what Bush/Cheney did was I-L-L-E-G-A-L. It's very simple. We live according to a rule of law in this country. No matter who you are, breaking the law has consequences. Bill Clinton wasn't impeached because he cheated on his wife or some other such personal moralistic conundrum. He was impeached because he lied in a deposition about his relations with Lewinsky. Think about that. And, based on Obama's initial response, it seems the perpetrators of easily the most appalling American scandal in at least thirty years will go unpunished. We can't let that happen. We cannot afford to sweep this under the rug. Our collective national conscience is at stake.

American Physicians supervise Waterboarding every day at the U.S. Navy's SERE(Survival, Evasion, Resistance, Escape) school in upstate Maine. Sure, its U.S. Military Aircrewman who volunteer for the duties that require the training, but its still Waterboarding. What about the physicians who attend Executions??? Don't they have a duty to stop a fatal dose of Potassium and Pentothal??? Maybe I'm just a Redneck Nazi, but I don't care if Torture's .0000000000000001% effective if that 1 is a major city getting nuked (even Cleveland).. And just curious is ANY meany treatment of terrorists OK... i.e. have an obese 12 year old sit and fart on the bad guys face, like happens to thousands of innocent American Kids every day?

"American Physicians supervise Waterboarding every day at the U.S. Navy's SERE(Survival, Evasion, Resistance, Escape) school in upstate Maine. Sure, its U.S. Military Aircrewman who volunteer for the duties that require the training,"

They can also leave by their own free will at any point and ring the bell, the most obvious point though, is that the seals know at the end of the day nobody is going to torture them to death.

"What about the physicians who attend Executions??? Don't they have a duty to stop a fatal dose of Potassium and Pentothal??? "

yes. much has been written on this, but I'd say this runs completely contrary to anything approaching the Hippocratic oath.

".0000000000000001% effective if that 1 is a major city getting nuked (even Cleveland).."

when you get to this level of statistical obscurity you start having to weigh the effects of the fall out of breaking human rights rules. And you open yourself up to just-as possible scenarios:

Imagine you are a street vendor in Afghanistan. You are on the fence about meeting with a CIA guy who promises to throw some money at you if you tell him about the guys you see meeting outside your house. But no, you read about those assholes torturing prisoners just like the @@#!ing Russians, and decide to play it safe.

I'd say that's just about as possible as someone cracking on their 111th water boarding (as opposed to their 1-110th water boarding)

ParaJJ-That argument is specious and vapid. Imagine what we could justify in the name of "training".

Besides, the actual purpose of the SERE training was to prepare special ops guys for torture techniques designed by KGB/Khmer Rouge criminals for the purpose of eliciting FALSE CONFESSIONS from prisoners. Ask John McCain; waterboarding is torture pure and simple.....

Thank you for your moral courage in presenting a highly controversial subject and making your own views about it known. You are likely to raise the consciousness of many medical professionals and perhaps even change the behaviour of some as they begin to become alert to questioning the boundaries of research and documentation around all types of traumatic physical action practiced upon human beings.

Of course there are many tentacles that can be explored using medical participation in torture as the worst-case scenario.

What do you and other medical professionals think about the questionable boundaries of invasive procedures in research hospitals as opportunities for professional advancement through research documentation and publishing? Are patients always INFORMED in their consent and active participants in deciding upon procedures and action that may be benefiting their medical team over the patient's own quality of life? Aggressive chemotherapy regimens and overtreating surgeries in cancer management are prominent examples.

In no way can hospital supported medical treatment action be compared to torture. Yet, the psychological and physical outcome can bear chilling parallels for the patient: patient physical mutilation and maiming due to overzealous surgeries, PTSD when patients realize their medical team practiced non-disclosure of important information or even lied regarding planned procedure, and unrecoverable quality of life.

Though policy, regulation, and law are important structures for preventing abuse in interrogation and in medical "treatment", the value and power of medical professionals communicating and discussing these matters amongst themselves cannot be underestimated.

Feel sorta left out without my Self Righteous Indignation Hat, so here I go..... I'll get upset about Aggressive Interrogation of Terrorists when Y'all get upset about Aggressive Termination of Pregnancies... the doctors do more than stand by during those...and I know the Supreme Court said its OK, they said the same thing about slavery 150 years ago...

Cheap shot with the "Herr Cheney" jab... his ancestry is English-Irish-Welsh...Bush/Cheney did sumthin illegal?? and from all the Ruckus, sumthin pretty big-time, not just Gamblin' at Rick's place. Then arrest em, take it up with a Grand Jury and give em their day in court.They're out of office now, probably not to hard to find. Who's that new Sherriff in town? Hussein something?? Otherwhise STFU,

Thank you for pointing out the imbalance between the Monica thing and torture. But I predict we won't go after anyone in the Bush/Cheney administration precisely BECAUSE of Monicagate. The impeachment cost nearly $50 million just for the special prosecutor, let alone all the government employees who had to take time out of their jobs. It also cost us emotionally. Do you know anyone who didn't feel tired and dirty when it was all over? I'm just as sick as you are about the torture, and I'm just as outraged that it was done in all our names, but I can't get excited about the idea of more years of legal proceedings and overheated headlines.

Besides, in the end, the impeachment really was about sex. It's hard for Americans to reach a national consensus about many things, but one thing that we can all agree on is that whatever kind of sex other people have is wrong.

I think its very easy to sit back in our high chairs and talk about morale courage and such. Its so simple. Right? So I would like to pose this terrible thought. What would you do if someone kidnapped your little girl and you caught one of the perps? Now you want your daughter back... right? but the scum bag piece of trash just smirks and laughs at your suffrage. You now have a choice. You can take your high moral ground and let your child die, or you can put him through some controlled pain that will not actually harm him and gain the information needed to get your girl back.

Anon-Your reasoning is so far off base I don't know where to begin. You're talking about some sort of far fetched, personalized ticking time bomb scenario. What does that have to do with a state sponsored, systematic torture program that borrowed techniques from condemned regimes in the Kremlin and Cambodia?

Your smug indignant attitude doesn't have a place in the pragmatic world of reality. The world is filled with bad people. Smiling at them and saying "Thank you sir. May I have another?" doesn't get you anywhere but having your head chopped off.

Making our people out to be some kind of enemy and comparing them to Nazi's makes me want to puke. These people took on the responsibility and made the tough decisions that needed to be made.

I guess we just should let the next attack come. We should do nothing to reduce their ability to hurt us again. Maybe you should look at how precisely they attempted to prevent real harm to the enemy instead of spinning it into some Nazi crap.

So, please answer the original question; What would you do if your child was in harm's way if you had one of the bad guys in your custody? He is refusing to give you the information needed to save your child's life.

Would you:

A.) utilize techniques that you have damned in this post to get the information?

B.) give the 'prisoner' hot meals and comfort, hoping that you'll be lucky enough to find your child without his information.

Now it's not a secret. It was secretive while we doing it though. Remember "we do not torture" from GWB? And what youre asking me about with regards to a personal threat to me or my family has no connection to state sponsored torture of detained POW's. You obviously cannot comprehend this. So please stop posting the same inane question ad nauseum. That's like saying "what would you do if you had fifteen minutes alone in a room with your brother's murderer?" All of us think we would act a certain way but that's not how we conduct ourselves in this thing called Western Civilization. There is a rule of law. Vigilante lawlessness is not allowed. The perpetrator is prosecuted and sent to jail or the elctric chair. Personal vendettas are no paradigm for how the world's greatest power ought to treat its unarmed POW's.

Read Ali Sufan's (the lead FBI interrogator of Abu Zubaydah) op ed in the NY Times about how all the actionable intelligence from Zubaydah was gleaned via traditional FBI interrogation:

"There was no actionable intelligence gained from using enhanced interrogation techniques on Abu Zubaydah that wasn’t, or couldn’t have been, gained from regular tactics. In addition, I saw that using these alternative methods on other terrorists backfired on more than a few occasions — all of which are still classified. The short sightedness behind the use of these techniques ignored the unreliability of the methods, the nature of the threat, the mentality and modus operandi of the terrorists, and due process."

This all comes down to what your definition of "Torture" is. I think its something really disgusting and Painful, like getting 2,000 Volts to the testicles or listening to Hilary Clinton speak.You think it's having some water tossed in your face and a caterpiller thrown in your cell.. I myself underwent what some might call torture, hours of sleep deprivation, interrogation by psychopathic S&M freaks, exposure to deadly infectious diseases, its called "Med School/Residency" hmm you may be right, I WOULD like to see some of those Bastards in jail...

You are an excellent fighter, well educated and obviously smarter than most (i am not being flippant here). I understand your position. But I don't agree with it.

I don't understand why you cry for people who wish to see the end of western civilization while you spit on those who are doing their best to protect it. You take the bold stand of righteousness, but fail to be strong enough to answer the question. You want to call these people POWs. I call them human trash. They self-proclaim the love of death. They speak of hatred for life. They wish to spread fear and desire the destruction of anything which does not conform to their religion. You want to give them more rights than those in the CIA. I view these documents as evidence that everything was done to obtain information which may have been otherwise withheld. It was documented and vetted through a process that was clearly conscious of the extenuating circumstances and all measures were then taken to reduce the risk of harm to the enemy. That is humane, and incredibly more than what they did to those 3,000 people in NewYork and those Jumbo-Jets. Not withstanding the brutality that they exhibit on a daily basis not only to those they profess as enemies to thier religion but also within their own culture to their women.

Humanity oughts not be. Hope that you would find consolation in knowing that humanity still provides the basis for us to rise from the ashes. Look at Europe today, for example, 64 years after it was reduced to rubble in WW2.

Torture. Is it legal? Ethical? Effective? Essential? To those who have been there and survived, my guess is that many of them would say it's a "skill" that we wish we could unlearn.

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